Who will be in charge is an important question. Perhaps the
most crucial of all. Given the potential human and financial
costs - the unnecessary loss of trust, reputation, lives,
careers and money.

Under HM Government plans for the NHS, it seems that
no single body - Department of Health, NHS
Commissioning Board, NHS England, Monitor or the Care
Quality Commission – will have the responsibility,
authority and powers to monitor the health system as a
whole, to identify potentially destabilising trends, and to
respond to them with concerted action.

Providers will have a joint licence, that is overseen by
Monitor and the Care Quality Commission. The CQC will
monitor safety and quality. It will address failure to meet
standards and the CQC will inspect against essential levels
of safety and quality.

Monitor will be charged with ensuring that competition works
in the interests of patients and taxpayers. If and when price
regulation is necessary, Monitor will set prices for NHSfunded
services, to promote fair competition and drive
productivity.

The Independent NHS Commissioning Board will resource
allocation and work directly with commissioners. It and the
NHS will be held to account through a set of national
outcome goals, part of the wider NHS Outcome Framework.

The Department of Health’s duties for the NHS will shrink
and be far more strategic, looking to improve public health,
tackle health inequalities and reform adult social care.

While the Secretary of State will hold the NHS Commissioning
Board to account. He will set legislative and policy
frameworks for which the NHS works.

In the meantime, what steps are being taken to prevent
systemic risk threatening the quality, activity and funding of
health services. Who is in the driving seat? Are other
Ministers and opposition MPs involved? What expertise is
being tapped into? Are ‘special forces’ officials ready to spring into action, to be
seconded specifically to deal with systemic risk?

Fingers and toes crossed that there are robust plans in
place to address these questions and that they there will not
be another NHS crisis. And if the answers are insufficient, at
least we’ll know who is in charge.

Someone who has to answer directly to Parliament, the
Secretary of State for Health. The buck stops with him.

A new website featuring every UK law in full is now available for free.

Launched by The National Archives, you can now scrutinise 6.5 million laws documents in England, Scotland, Wales and Northern Ireland. They are stored as PDF files.

“This is the public’s statute book,” said Lord McNally, minister of state and deputy leader of House of Lords.

legislation.gov.uk presents complex information in a clear and intuitive way. Lord McNally continued that the website is groundbreaking and that it puts democracy at the heart of legislation. The website makes a major contribution to the government’s transparency agenda.

The website replaces The Office of Public Sector Information and Statute Law websites.

The health White Paper promises significant changes to primary care and the way that healthcare is delivered.  BMJ Masterclasses aimed at clinicians and managers in primary care will equip GPs and their practices to meet the challenges and take the opportunities that lie ahead.

Understanding GP Commissioning, is a new one day course providing practical skills and advice on general practice commissioning, as well as

an essential overview of the recent health White Paper. It takes place at BMA House, London, on 30th September.

Improving Quality in Your Practice, takes place at BMA House, on 1st December. It will help GPs identify areas in their practice where they can improve quality and safety by working smarter, not harder, and develop an action plan for their surgery.

For details, click www.betteroutcomes.org/events

However, things are less clear when we compare NHS
quality and activity. Statistics come to the fore. We
compare the NHS with the EU, north America and
Australasia. And we might be missing a trick.

Could it be that there are better healthcare systems
elsewhere in the World? Healthcare systems that
deliver more at less cost.

Take Japan for example. It stands at or near the top in
every comparative ranking of healthcare quality, activity
and cost.

Not alone is their healthy life expectancy 6% higher
than in the UK, they also have the best recovery rates
from just about all of the major diseases. Japan
leads the World in curing the diseases that
can be cured. Impressive.

The percentage of people dying from circulatory
diseases per 100,000, is 75% less than here. The
proportion of cardiac death is four times less. The birth
rate is 30% less and the proportion of the Japanese
population that is obese, is one seventh. Although the
percentage of daily smokers in Japan is higher -
30.3%, compared to 26% in the UK.

Cost control is one of the key drivers of Japan’s
success. It’s savings in the high-tech realm can be
awesome. An MRI scan of the neck region in Japan
routinely costs 9% of one in the US.

All 125 million residents have access to healthcare
services. The Japanese see a Doctor about three times
as often as people here in the UK, or those with
healthcare insurance in the US. The number of Nurses
per 1,000 people in Japan is less than in the UK : 7.8,
compared with 8.8 in the UK.

And they have almost three times as many hospital
beds per 1,000 people. The average hospital stay is
four times the US average. The Japanese get twice as
many prescriptions and three times as many MRI
scans.

And the cost of caring for every person living in Japan
is less than half that of caring for the 80% of Americans
with health insurance. Total expenditure is less
than in the UK too - 7.8% GDP versus 8.1%.

So what do you think?

Post your thoughts below.

With over 1,500 safety practitioners working in healthcare, the IOSH Healthcare Group has just announced its autumn conference. Taking place in Cheshire on 21st September, the programme explores corporate accountability corporate manslaughter, violence in the workplace and the role of Directors and Managers for health & safety. Presentations will be delivered by members of the Group, University of Glamorgan and Morgan Cole solicitors.

For details, click ‘events’ at www.betteroutcomes.org

Channel 4 News reported that 17 NHS Doctors signed compromise agreements  each year since 2000

Read the full story at the ‘news’ page at www.betteroutcomes.org

Meanwhile, the Social Partnership Forum published their guide in July, promoting best practice in devising, implementing and auditing whistleblowing

policies and procedures. Link to it at ‘publications’ at www.betteroutcomes.org

“The contribution of SHA and PCT staff to achieving improvements in health care over recent years must not be underestimated.

Dr Peter Carter,  RCN Chief Executive & General Secretary,  20th July 2010. To read the full article, click ‘news’ at www.betteroutcomes.org

DH is retaining the NHSLA. But, read on.  60% of acute trusts, 31% of mental health and learning disability trusts, 70% of maternity services and no ambulance trusts were at levels 2 or 3 of NHSLA’s risk management standards in March of this year.  Solicitors succeeding in clinical negligence claims bill up to £450 per hour, and a success fee of 100%. NHSLA secures the very best of the defence market for £205 an hour, and no success fees. But, DH is exploring opportunities for greater commercial involvement. NHSLA is relocating to offices in London and Harrogate.

Link to NHSLA’s annual report via ‘publications’ at  www.betteroutcomes.org

Published in July,  Equity and Excellence : liberating the NHS looks towards an NHS in England - that is slimmed down, smartened up and democratised to deliver better quality care.  Out goes what remains of Aneurin Bevan’s nationalised vision, and out too is the New Labour Government’s regime of process targets, replacing them with outcomes measures.

There will be a new role for Local Authorities to facilitate closer working between health and social care services, to support patient choice, to improve public health and enhance commissioning.

The White Paper spells out Government plans to make the NHS more competitive, with NHS Providers being more accountable and transparent.

England’s 35,000 GPs will have control of about £70bn. Clustered in GP Consortia, they are to be given freedom and responsibility for buying care from Providers, within and outside the NHS. GPs will be unable to generate a surplus. And should they fail, they will not be personally liable.

While Monitor superintends NHS Foundation Trusts at the moment,  the White Paper proposes to turn Monitor into a full-blown economic regulator to oversee a healthcare market in the same way that Ofcom and Ofgem oversee the markets in communications and energy.

Consideration will be given to abolishing the cap on private income that NHS Foundation Trusts can earn and whether any surplus can be re-invested in the organisation, although they will not be privatised.

While GPs may find sufficient power to shelter from the full impact of competition, Liberating the NHS challenges doctors too. Patients will get more choice and control. This will be backed by an information revolution to involve Patients in their care, designed around them and achieving, in Mr Lansley’s words, No decisions about me, without me.

March 2014 is an important milestone for NHS Trusts - they will be or have become part of, an NHS Foundation Trust. They will be subject to regulation from Monitor, and will be given new freedoms as part of the largest and most vibrant social enterprise sector in the world.

The Secretary for State will hold the NHS Commissioning Board to account for delivering better health outcomes through a national NHS Outcomes Framework.

Link to all of the Department of Health’s Liberating the NHS consultations at the ‘consultations’ pages at www.betteroutcomes.org

Statistics (from www.nationmaster.com)

Population density in Japan is 37% higher than here in the UK. Their Life expectancy at birth is 4% higher and Healthy life expectancy is 6% higher.

The birth rate per 1,000 people is 30% less and the proportion of the population that is obese in the Japan is one seventh that in the UK.  The percentage of daily smokers in Japan is higher - 30.3%, compared with 26% in the UK.

The percentage of people dying from circulatory disease per 100,000 people in Japan, is 75% less and the proportion of deaths from heart disease per 100,000 is four times less than in the UK. Infant mortality per 1,000 live births is 2.8 in Japan and 4.93 in the UK.

Total Expenditure on health services as % of GDP in Japan is less than in the UK - 7.8% versus 8.1%. They have almost three times as many Hospital beds per 1,000 people.

While the numbers of Physicians per 1,000 people are similar in Japan and the UK, people in Japan have three times as many consultations with Doctors.

The number of Nurses per 1,000 people in Japan is less than in the UK - 7.8, compared with 8.8 in the UK.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org